Ciavarella A, Mustacchio A, Silletti A, Franchi R, Levorato M, Campieri C, Borgnino L C, Capozzi G, Morotti L, Vannini P
Department of Metabolic Diseases, St. Orsola Hospital, Bologna University, Italy.
Eur J Med. 1992 Sep;1(5):268-72.
To investigate the effect of low doses of the angiotensin converting enzyme inhibitor enalapril on renal haemodynamics and albuminuria in normotensive and hypertensive type 1 (insulin-dependent) diabetic patients with incipient or overt nephropathy.
Twenty-two type 1 (insulin-dependent) diabetic patients with persistent microalbuminuria or macroalbuminuria and normal serum creatinine were studied. Of all patients, 16 males and 6 females, age 45 +/- 13 years, diabetes duration 19 +/- 11 years, insulin dose 38 +/- 11 U/day, 10 were normotensive and 12 were hypertensive. After 3 months of run-in period the patients were assigned to treatment with 5 mg or 10 mg enalapril based on the presence of normotension or hypertension respectively. Before and after 6 months of treatment, renal function was assessed by evaluation of glomerular filtration rate (99m Tc-DTPA), renal plasma flow (131-I iodohippurate), filtration fraction and renal vascular resistance. Mean arterial pressure, albumin excretion rate, urinary urea excretion and glycated haemoglobin were also determined.
Administration of enalapril resulted in both groups of patients in a significant fall in mean arterial pressure, albumin excretion rate, glomerular filtration rate, filtration fraction, and renal vascular resistance. Decreasing albumin excretion did not correlate with a drop in systemic blood pressure or filtration fraction. No significant variations were observed in renal plasma flow, in urinary urea excretion or in glycated haemoglobin.
Our results suggest that low doses of enalapril are effective in influencing renal haemodynamics and reducing urinary albumin excretion in both normotensive and hypertensive type 1 (insulin-dependent) diabetic patients with incipient or overt nephropathy. The lowering effect of the angiotensin converting enzyme inhibitor on albuminuria seems to be independent of the action on systemic blood pressure and renal haemodynamic changes.
研究低剂量血管紧张素转换酶抑制剂依那普利对血压正常和高血压的1型（胰岛素依赖型）糖尿病早期或显性肾病患者肾脏血流动力学及蛋白尿的影响。
对22例持续性微量白蛋白尿或大量白蛋白尿且血清肌酐正常的1型（胰岛素依赖型）糖尿病患者进行研究。所有患者中，男性16例，女性6例，年龄45±13岁，糖尿病病程19±11年，胰岛素剂量38±11U/天，其中血压正常者10例，高血压者12例。经过3个月的导入期后，根据是否为血压正常或高血压分别给予患者5mg或10mg依那普利治疗。治疗6个月前后，通过评估肾小球滤过率（99m锝-二巯基丁二酸）、肾血浆流量（131碘-马尿酸钠）、滤过分数和肾血管阻力来评估肾功能。还测定了平均动脉压、白蛋白排泄率、尿尿素排泄和糖化血红蛋白。
依那普利给药后两组患者的平均动脉压、白蛋白排泄率、肾小球滤过率、滤过分数和肾血管阻力均显著下降。白蛋白排泄减少与全身血压或滤过分数下降无关。肾血浆流量、尿尿素排泄或糖化血红蛋白未见明显变化。
我们的结果表明，低剂量依那普利对血压正常和高血压的1型（胰岛素依赖型）糖尿病早期或显性肾病患者影响肾脏血流动力学及减少尿白蛋白排泄有效。血管紧张素转换酶抑制剂对蛋白尿的降低作用似乎独立于其对全身血压和肾脏血流动力学变化的作用。
